Ask Women About Sex Assault, ACOG Says

Action Points

Explain that screening for sexual assault should be a routine component of healthcare for women, according to a committee opinion from the American College of Obstetricians and Gynecologists.

Note that physicians who examine women who have been assaulted need to be aware of the medical and legal requirements of the evaluation, including the necessity for obtaining informed consent, to provide infectious disease prophylaxis and emergency contraception as appropriate, and to report the event to the proper authorities.

Screening for sexual assault should be a routine component of healthcare for women, according to a committee opinion from the American College of Obstetricians and Gynecologists.

A national survey found that each year there are more than 300,000 sexual assaults against women in the U.S., and the number is probably higher because many are never reported.

Almost 20% of women in the survey reported having had such an assault at some point during their lives -- and more than half occurred when the victim was younger than 18.

In addition, there are an estimated 32,000 pregnancies resulting from rape every year.

"Healthcare providers who routinely screen for a history of sexual assault are better able to identify victims of sexual assault and thereby provide tertiary prevention of long-term and persistent physical and mental health consequences of sexual assault," the college stated in the committee opinion, which is being published in the August issue of Obstetrics & Gynecology.

These consequences include pain, problems with eating and sleeping, and emotional difficulties including fear, anxiety, and humiliation in the days and weeks following the assault.

Later developments can include gynecologic symptoms, phobias, post-traumatic stress disorder, and alcohol or drug abuse.

Women who have been victims of a sexual assault who don't report the crime may later present with symptoms such as pelvic pain or dysmenorrhea, and clinicians should be aware that procedures such as pelvic exams in these women can produce anxiety or panic, according to the committee opinion.

"In recent years, there has been a trend toward the implementation of hospital-based programs to provide acute medical and evidentiary examinations by sexual assault nurse examiners or sexual assault forensic examiners," the college opinion piece noted.

However, physicians still are called upon to examine women who have been assaulted -- and need to be aware of the medical and legal requirements of the evaluation.

These include the necessity for obtaining informed consent, to provide infectious disease prophylaxis and emergency contraception as appropriate, and to report the event to the proper authorities.

The possibility of HIV infection is a particular concern in these circumstances.

If the attacker is HIV positive and the woman reports the assault within 72 hours, she should promptly be given a month-long course of highly active antiretroviral drug treatment, according to the college.

In case of uncertainty as to the HIV status of the assailant, clinicians can weigh the potential benefits of prophylaxis against the risks of adverse events associated with the drugs.

The clinician also should arrange for trained personnel to follow up with the patient, and provide clear instructions for the patient in writing.

"There is a long list of physical and emotional health problems that follow a history of abuse," said Veronica Gillispie, MD, of the college's Committee on Health Care for Underserved Women, who helped develop the committee opinion.

"By identifying victims of sexual assault and encouraging them to report their abuse, these problems can be better addressed and even prevented," Gillispie said in a statement.

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